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Côte D'ivoire in Collaboration with Several Individuals and Organizations Survey on the Determinants of Malaria- Related Behaviors in Côte d’Ivoire Malaria Behavior Survey Report Submitted to: President’s Malaria Initiative Submitted by: Johns Hopkins Center for Communication Programs Cooperative Agreement #AID-OAA-A-17-00017 September 2019 Table of Contents Acronyms ....................................................................................................................................................... 2 Acknowledgements ....................................................................................................................................... 3 Preface ........................................................................................................................................................... 4 Summary ........................................................................................................................................................ 5 1 Introduction ................................................................................................................................................ 9 2 Methodology............................................................................................................................................. 10 3 Results ....................................................................................................................................................... 18 3.1 Description of the sample .................................................................................................................. 18 3.2 Media consumption and exposure to messages ............................................................................... 22 3.3 Cross-sectional ideational determinants ........................................................................................... 28 3.4 Long lasting insecticide-treated nets (LLIN) ...................................................................................... 33 3.5 Treatment of malaria cases in children under the age of five; ......................................................... 50 3.6 Malaria in pregnancy ......................................................................................................................... 59 3.7 Indoor Residual Spraying (IRS) ........................................................................................................... 75 4 Conclusions and Recommendations ......................................................................................................... 79 5 References ................................................................................................................................................ 85 6 Appendix ................................................................................................................................................... 86 Survey of Determinants of Malaria-Related Behavior in Côte d’Ivoire, 2018 | 1 Acronyms ANC Antenatal Care CCP Center for Communication Programs CNER Comité National d’Éthique et de Recherche IPTp Intermittent Preventive Treatment of Malaria in pregnancy LLIN Long Lasting Insecticidal Net MICS Multiple Indicator Cluster Survey NIS National Institute of Statistics NMCP National Malaria Control Program NSP National Strategic Plan PMI President's Malaria Initiative SBC Social and Behavior Change SDG Sustainable Development Goal USAID United States Agency for International Development Survey of Determinants of Malaria-Related Behavior in Côte d’Ivoire, 2018 | 2 Acknowledgements The survey on the determinants of behaviors related to malaria was carried out by the Breakthrough ACTION (BA) project in Côte d'Ivoire in collaboration with several individuals and organizations. The BA project based at the Johns Hopkins Communication Center (CCP/ Baltimore, USA) is funded by the United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI). We acknowledge several individuals and organizations who contributed to the design and implementation of the survey reported in this document. Our sincere thanks to the Ministry of Health and Public Hygiene through Dr. Antoine Mea TANOH, Director-Coordinator of the NMCP, and his team for their support throughout the implementation of this study. We are particularly grateful to the administrative, health district and community leadership of the localities selected for the survey (prefects, vice-prefects, regional directors of health, departmental health directors, mayors, traditional chiefs, and community and religious leaders) and to the populations of the areas surveyed. We would like to thank the OMEDIA team, supervisors, and investigators for their professionalism and dedication to data quality. Our appreciation goes especially to PMI / USAID for their technical and financial support. We are grateful to colleagues from PMI in Ivory Coast (Dr. Blaise Kouadio, Dr. Andre McKenzie, Dr. Andre Zandra) and Washington DC (Donald Dickerson, Nene Diallo) for their invaluable insight and advice. Finally, our special thanks go to Dr. Stella Babalola, Director of Research and Evaluation at CCP/ Baltimore, who led the research team as principal investigator and to co-investigators Abdul Dosso (BA, Côte d’Ivoire) Grace Awantang (BA/CCP, Baltimore) and Monne Therese Bleu (National Malaria Control Program [NMCP], Côte d'Ivoire). We also thank Olamide Oyenubi (BA/CCP, Baltimore) for her role in helping to analyze part of the data presented in this report. We are grateful to members of the report writing team: Professor N'Doumy Noel ABE (Scientific Support Group of the NMCP), Léa Isabelle GORIS (NMCP), Anicet EHUI (NMCP), Isaac Hans BAHIBO (Impact Malaria / PSI), Daouda DOUMBIA (PNSME), Charles GNAKRI (UNICEF), Jacob AGNIMA (Save the Children), Mieko McKay (BA, Côte d'Ivoire), Abdul Dosso (BA, Côte d'Ivoire), Amadou Diabate (BA, Côte d'Ivoire), Antoine Tanoh Kouame (BA, Côte d'Ivoire), Blaise N'Dri (BA, Côte d'Ivoire) and Stella Babalola (BA, Baltimore). This team met in Grand Bassam in December 2018 to review the data and prepare the first draft of this report. We also acknowledge the contribution of other Breakthrough ACTION colleagues Michael Toso, Cori Fordham, Gabrielle Hunter, Lynn Van Lith and Daniel Christian Koko for reviewing the survey protocol and earlier versions of this report. Diarra Kamara Country Director, Breakthrough ACTION/Centre des Programmes de Communication Abidjan, Côte D’Ivoire Survey of Determinants of Malaria-Related Behavior in Côte d’Ivoire, 2018 | 3 Preface Every year in Côte d'Ivoire, a significant proportion of children and women are infected with the malaria parasite. Since 1996, the fight against malaria has been one of the priorities defined in the various National Health Development Plans in the country. And after more than twenty years of efforts to combat malaria, we are beginning to see significant improvements. It is against this background that I laud the collaboration between the Ministry of Health and Public Hygiene through the National Malaria Control Program and its partners that has made the design and implementation of the Malaria Behavioral Determinants Survey possible. The data will allow us to better understand the scale of the epidemic, and to develop adequate guidelines and strategies for malaria control. Findings from this survey will provide a better understanding of the socio-demographic and psychosocial characteristics associated with malaria-related behaviors in Côte d'Ivoire. The implementation of this survey was a collaborative effort of Breakthrough ACTION, the NMCP, United States Agency for International Development through the United States President's Initiative for the fight against malaria, national experts from various ministries and stakeholders involved in the fight against malaria. The Malaria Behaviors Determinants Survey provides an opportunity to obtain reliable national and regional data on the status of malaria in Côte d'Ivoire. As such, the findings will allow us to determine the appropriate focus of programmatic activities designed to influence relevant psychosocial factors associated with malaria and to improve behaviors. I would like to advocate an effective exploitation of the data to all actors and partners involved in the fight against malaria for in order to translate the national strategy and the relevant recommendations into action. I take this opportunity to reiterate the government's thanks to the development partners who have made a decisive contribution to the realization of this important survey. In particular, I express my gratitude to United States Government through USAID and PMI. I congratulate Breakthrough ACTION, PMI, my NMCP team, national experts, including the NMCP Scientific Support Group, and all the researchers whose dedication and expertise have made this survey possible. I would like to thank the administrative, political, traditional and religious authorities, the civil society organizations and the residents of the study communities for their contribution and support. Finally, I would like to call for a general mobilization of all relevant actors so that together we meet the challenges for achieving the Sustainable Development Goals (SDGs). TANOH Méa Antoine Director-Coordinator of NMCP Abidjan, Côte D’Ivoire Survey of Determinants of Malaria-Related Behavior in Côte d’Ivoire, 2018 | 4 Summary Breakthrough ACTION collected relevant information from 5,969 households, 6,749 women and 1,930 men. The data collected are representative at national, regional as well
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